Statins May Cut Pneumonia Risk (CME/CE)
randomized 17,802 healthy participants (men 50 years and older and women 60 and older) with an LDL cholesterol level below 130 mg/dL and a high-sensitivity C-reactive protein level of 2.0 mg/L or greater to double-blind treatment with either rosuvastatin or placebo.
The primary trial results showed a 44% reduction in the rate of myocardial infarction, stroke, arterial revascularization, or death from cardiovascular causes with the lipid-lowering medication, leading the FDA to grant the drug an indication for of cardiovascular disease.
But the trial collected plenty of other data, including adverse events recorded by blinded investigators on an intent-to-treat basis.
During the median 1.9 years of follow-up during the trial, 214 rosuvastatin users developed pneumonia compared with 257 in the placebo group (1.1% versus 1.4%).
Accounting for recurrent pneumonia, the relative risk reduction remained significant at 19% for the lipid-lowering drug compared with placebo (HR 0.81, 95% CI 0.67 to 0.98).
Further adjustment for age, sex, smoking status, metabolic syndrome, lipid levels, and C-reactive protein levels didn't change the apparently protective effect of the statin.
The drug appeared to have little effect early in the treatment period of the trial but a bigger impact later on, particularly after two years (HR 0.58, 95% CI 0.39 to 0.85).
The rate of other types of infection, including overall respiratory infections, didn't differ significantly between groups.
"Potential mechanisms that might support a protective effect of statins for infectious diseases include mild anti-inflammatory, antioxidant, immunomodulatory, anti-apoptotic and endothelial protection," Novack's group suggested.
The randomized trial setting cut down on the likelihood that the statin findings were confounded by better health habits, better access to care, and other factors.
However, the analysis wasn't part of the original design of the study and relied on adverse event reporting, which may have missed some pneumonia cases.